Flashback to a year ago: I’m a third-year medical student, three weeks into my very first clinical rotation—acute-care surgery at our county hospital.
It’s nearing dinner time, less than halfway through my twenty-eight-hour call shift, when my pager buzzes, alerting me to an incoming trauma. Looking down, I read three letters: “GSW.”
After three weeks, those three letters no longer faze me. “GSW” (gunshot wound) has become as routine as “MVC” (motor-vehicle collision) or “AVP” (auto vs. pedestrian)—so frequently displayed that just hours into my first overnight call, I’ve realized that the question isn’t if but when those letters will call me into action in the emergency department.
This time is like all the others. As our patient arrives, the emergency-medicine residents and trauma surgeons quickly go to work, checking airway, breathing, circulation—an almost choreographed dance carried out amid the chaos and perfected by daily experience.
I watch as they stabilize the patient and attempt to assess the damage, working hard to identify which injuries are the most life-threatening. I’m told that one bullet entered through the left flank, but left no exit wound. The ultrasound indicates bleeding within the patient’s abdominal cavity, his blood pressure is dropping, and he is whisked to the operating room.
I follow along nervously, trying hard not to get into anyone’s way or, worse yet, break the sterile field. As the team performs an exploratory laparotomy, I stand in awe, face to face with living internal organs I’d previously viewed only in textbooks and Zoom lectures.
I soon begin to see the destruction caused by that one bullet—damage so extensive, it’s as if the bullet played a game of pinball in the patient’s abdominal cavity. The surgical team works to seal the perforations in the small intestine and stomach, only to find a clear opening in the diaphragm. We double-check the patient’s X-ray and see the bullet light up the space between his diaphragm and lungs.
The team decides that it’s too dangerous to remove it, so we close up, and the patient is taken to the surgical ICU. The next day he asks for Jell-O, and his recovery begins.
He is lucky.
I’ve never before seen the true extent of damage that a single bullet can cause. I’d heard about the dangers of guns on the news—the tragedies of mass shootings and the stories of gang violence. I’ve watched as politicians, activists and my casual Instagram following have united in support of common-sense gun laws to ban military-grade weaponry capable of spewing out forty-five rounds in a single minute, leaving so many dead, and forever changing communities like my childhood hometown, Parkland, Florida. Yet here I’ve just witnessed a tragedy that won’t make it onto the news: one lone bullet from a regular handgun.
I’ve noticed an unspoken reluctance among medical professionals to talk about the consequences of the violence that many of us witness in our emergency departments each and every day. Maybe this stoicism is ingrained in our culture, which places value on people’s ability to uphold a façade of strength and emotional stability—or maybe it’s just easier to become numb. In trauma surgery, the unrelenting demands can make it almost impossible to take a moment to reflect: Our pagers will not stop buzzing, and the next patient deserves our full and undivided attention.
Looking back twelve months to my then twenty-four-year-old self, I realize that by the end of my three weeks on service, and after countless similar stories, I too had become numb to the shock of GSW.
Now, as I enter my fourth year and prepare to apply to residency programs in my chosen specialty, general surgery, I want to make a promise to my future self.
I promise myself never to go numb, and never to find the carnage of gun violence normal.
As I continue my medical training, it may seem easier to stop feeling entirely in order to avoid emotional burnout and compassion fatigue, but I believe that taking the time to feel is what’s truly most important. The elation at a good outcome, the sorrow of a patient’s death and even the jolting disturbance of gun violence are meant to be felt.
Our ability to feel is what keeps me and my fellow providers questioning. It’s what keeps us fighting for our patients each day.
It’s what keeps us human.
9 thoughts on “Another GSW”
Imagine you have been entrusted with a piece of your great-grandmother’s heirloom fine china. The family story is that at a holiday dinner one year your late great uncle spied that dish and exclaimed, “My mother used to serve us potatoes on that!” And ever since then that piece has come out to serve the potatoes at family holiday dinners. Your great-grandmother, great uncle, and others of prior generations are long deceased, but their gifts and stories are very much alive in those who sit around the family table today. And you share potatoes served on that dish.
But today as you come around the corner into your kitchen, carrying that dish with intent to wash it for an upcoming holiday meal, your toddler zooms around the corner, too, swerves to avoid you in awkward toddler style, slips, falls, hits his head on a drawer handle, and lands crying and bleeding in front of you. You set great-grandma’s dish down on the counter, and quickly tend to your child. Of course you do! But when the emergency has passed, the child duly bandaged or sutured or whatever other care the injury requires rendered, and they have been comforted and peace restored, you go back to great-grandma’s dish and all the history and family significance it holds, and lovingly ready it for the next family holiday meal. Of course you do!
For a few moments, or an hour, or however long it took to take your child to the ED for sutures, your great-grandmother’s family heirloom was the absolute last thing on your mind. But you didn’t forget or lose it, nor discount its value or its history; rather, you set it aside for a time in order to attend to a more pressing need. And the care and compassion you showed your child in that moment likely was deeply rooted in the love and strength that has surrounded you all your life, in the family that ate potatoes year after year from great-grandma’s dish. That dish, with the faded trim and chip missing from one corner is invaluable, and you treasure and care for it.
May it ever be so with your feelings as you progress throughout your medical career. May you not grow “numb,” but rather learn to set feelings aside in order to render aid when your patients need you. And when you are an attending may you be vulnerable enough to talk with your medical students and residents, teaching them to stay whole, to prioritize for the needs at hand, but never to grow “numb,” no matter how you and they sometimes may appear in the stress of a moment. Great-grandma’s “dish” will be right there on the counter where you left it when the GSW rolled into your OR. May you always go back to it when the work of the moment is done. As great-grandma’s dish and the anchor, identity, and love it came to represent define, guide, and strengthen you, so will the array of feelings and full human responses that you set aside when a medically skilled and clear-headed response is needed. May you always prioritize, but when the needs and drama of a moment have passed may you never forget to reclaim your full, rich humanity, with its wonders and foibles alike, and return to that which you set aside.
Keep on caring.
Keep on writing.
Thank you for this. Keep working on this where ever you land in your residencies and your practice. Washington State just outlawed AR15 assault weapons and we are hoping that will help. We still a lot of gun violence though. Our country needs all hands on deck when trying to stop gun violence.
“I promise myself never to go numb, and never to find the carnage of gun violence normal.”
May this aspiration, prayer stay with you for years to come.
Beautifully and sensitively written. Thank you.
Thank you for your commitment to feeling. It’s moving to hear this articulated and I agree about the value of acknowledging emotion.
Thank you for allowing us into your head and into your ER. I shared this; it’s too important not to.
As a UK resident, while we have our own shooting incidents , it is so hard to understand the casual acceptance of guns in the USA. I do hope this brilliant description of the impact of a single bullet gets widespread circulation. I will certainly tweet it here.
Heartfelt.
Sincere.
Poignant.
Please fight to keep this perspective. It will be hard.
Beautiful piece. I hope you can keep that promise! Save this story and read it to remind yourself when you start to feel detached.